| NPI | 1447252556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60878930) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A71075) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2026-06-17 |